Checklists are some of the most valuable tools we have available in quality improvement and patient safety. They are simple and save time in the long run and help you remember to do things you might otherwise overlook. We’ve discussed the WHO Surgical Safety Checklist and its successful implementations often (see our Patient Safety Tips of the Week for July 1, 2008 “WHO’s New Surgical Safety Checklist”, September 23, 2008 “Checklists and Wrong Site Surgery”, and January 20, 2009 “The WHO Surgical Safety Checklist Delivers the Outcomes”). There have also been modifications of the checklist for radiologic interventions (see our June 2010 What’s New in the Patient Safety World column “WHO Checklist for Radiological Interventions”), cataract surgery (see our June 8, 2010 Patient Safety Tip of the Week “Surgical Safety Checklist for Cataract Surgery”, and others.
Another one we have not yet discussed is the WHO Safe Childbirth Checklist (Spector 2012). This checklist was developed in attempt to improve global childbirth practices. It is a simple 29-item checklist that applies (mostly) evidence-based recommendations at key times during the childbirth process. Spector et al. implemented a pilot of this checklist in India. They demonstrated an improvement in compliance with practices on the checklist from 10/29 before to 25/29 after implementation. This pilot did show a trend toward reduction in stillbirths but was not powered to assess fetal and maternal outcomes.
Implementation was very low-cost and use of the checklist was readily accepted by medical personnel. The authors attributed success to 3 factors: (1) reinforcing the core set of practices by use of the checklist (2) a reminder to complete those practices at crucial times and (3) as a tool that highlighted gaps in existing practices.
Importantly, they point out that a checklist alone is not sufficient. The program provided education about best practices, identified existing gaps in care, empowered members of the local healthcare team, did focused training, discussed potential barriers, and established a mechanism for monitoring and program evaluation.
Next step, however, is making sure that implementation of the checklist translates into hard outcomes (saving lives, both fetal and maternal, and avoiding adverse outcomes).
Spector JM, Agrawal P, Kodkany B, et al. Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program. PLoS ONE 2012; published 16 May 2012
Table S1. Elements of the WHO Safe Childbirth Checklist.